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Pathophysiology: Afterload
• Systolic HF: Decreased amount of blood from - Resistance in left ventricle must overcome to
the ventricle – stimulates sympathetic nervous circulate blood.
system – release of epinephrine and - Increased in afterload may indicate:
norepinephrine – further heart muscle damage a. Hypertension
– decreased renal perfusion – Renin secretion – b. Vasoconstriction
Angiotensin I production – ACE in the lumen – - Increased afterload, increased cardiac workload
Angiotensin II – causes vasoconstriction and
aldosterone production – fluid retention – Heart Failure
increases heart’s workload – ventricular
Signs and Symptoms:
hypertrophy without capillary blood supply –
myocardial ischemia General:
• Diastolic HF: Increased workload – cardiac - Pale, cyanotic skin (with decreased perfusion to
hypertrophy – decreased blood in the ventricles extremities)
– causes decreased cardiac output
- Dependent edema (with increased venous
pressure)
- Ascites Pathophysiology:
- Hepatojugular test, increased (with increased • Left ventricular failure→ pump failure→ back up
right ventricular filling pressure) of blood into the pulmonary veins → increased
pulmonary capillary pressure → pulmonary
Renal:
congestion
- Decreased urinary frequency during the day
• Left ventricular failure → decreased cardiac
- Nocturia output → decreased perfusion to the brain,
kidney and other tissues → oliguria, dizziness
Respiratory:
Predisposing Factors
- Dyspnea on exertion
-1. 90% is mitral valve stenosis due to
- Orthopnea
a. RHD – inflammation of mitral valve due to
- Paroxysmal nocturnal dyspnea invasion of Group A beta-hemolytic
streptococcus
- Bilateral crackles that do not clear with cough
- Formation of aschoff bodies in the mitral
New York Heart Association’s Classification of Heart
valve
Failure:
- Common among children (throat infection)
a. Class I: ordinary physical activity does not cause
chest pain and fatigue, no pulmonary - ASO Titer (Anti streptolysin O titer)
congestion, asymptomatic, no limitations in the
activity of daily living (ADL’s) (Good Prognosis) - Penicillin
- Aspirin 14. Nocturia – sleeping cardiac workload decreased,
improving renal perfusion, which then leads to frequent
b. Aging urination at
Predisposing Factors: Night.
2. Myocardial Infarction Left-Sided Heart Failure (CHOP):
3. Ischemic heart disease C- Cough
4. Hypertension H- Hemoptysis
5. Aortic valve stenosis O- Orthopnea
Signs and Symptoms P- Pulmonary Congestion (crackles/ rales)
1. Dyspnea
5. Frothy salivation
11. There is anorexia and generalized body malaise 3. Echocardiography – enlarged heart chamber
(cardiomyopathy), dependent on extent of heart failure
12. S3 – ventricular gallop
4. ABG – reveals PO2 is decreased (hypoxemia), PCO2 is
13. Oliguria – blood flow to the kidney decreases,
increased (respiratory acidosis)
causing decreased perfusion and reduce urine output.
(Daytime)
Diagnostic tests: 3. Ascites
• Pulse arterial pressure (PAP) and Pulmonary Right-Sided Heart Failure (HEAD):
capillary wedge pressure (PCWP): increased H- Hepatomegaly
RIGHT sided Heart failure E- Edema (Bipedal)
• Weakened right ventricle is unable to pump A- Ascites
blood into the pulmonary system; systemic
venous congestion occurs as pressure builds up D- Distended Neck Vein
Pathophysiology:
Predisposing Factors
Diagnostic Procedures
1. Tricuspid valve stenosis
1. Chest x-ray – reveals cardiomegaly
2. Pulmonary embolism
2. Central venous pressure (CVP)
3. Related to COPD
- Measure pressure in right atrium (4 – 10 cm of water)
4. Pulmonic valve stenosis
- CVP fluid status measure
5. Left sided heart failure
- If CVP is less than 4 cm of water hypovolemic shock
Signs and Symptoms (venous congestion)
- Do the fluid challenge (increase IV flow rate)
1. Neck/jugular vein distension
- If CVP is more than 10 cm of water hypervolemic shock
2. Pitting edema (lower extremities)
- Administer loop diuretics as ordered 9. Assist in bloodless phlebotomy – rotating tourniquet,
rotated clockwise every 15 minutes to promote
- When reading CVP patient should be flat on bed decrease venous return
- Upon insertion place client in Trendelenburg position 10. Provide client health teaching and discharge
to promote ventricular filling and prevent pulmonary planning
embolism
Prevent complications
3. Echocardiography – reveals enlarged heart chambers
(cardiomyopathy) a.Arrhythmia
Goal of Treatment:
- Increase force of cardiac contraction
• Eliminate or reduce any etiologic contributory
- If heart rate is decreased do not give
factors
c. Loop Diuretics Lasix (Furosemide) peak 1-2 hrs,
duration 6-8 hrs (monitor for hyperkalemia) • Reduce workload of the heart by decreasing
preloads and afterloads
d. Bronchodilators aminophylline
Medical Management:
e. Narcotic analgesics Morphine Sulfate
• Sodium and fluid restriction; weight reduction;
f. Vasodilators Nitroglycerine less than 2-3g of sodium per day
3. Administer oxygen inhalation with high inflow, 3 – 4 • Oxygen therapy depending on the client’s
L/min, delivered via nasal cannula condition
5. Monitor strictly vital signs, intake and output and ECG Pharmacology:
tracing
Major types of drugs used to treat CHF:
6. Measure abdominal girth daily and notify physician
a. Inotropic – affects cardiac contractility
7. Provide a dietary intake of low sodium, cholesterol
and caffeine b. Chronotropic – affects heart rate
Etiology:
Pathophysiology:
• Cardiac glycoside: digitalis to increase cardiac 2. Breathing: providing artificial ventilation by rescue
output breathing